How many polyps need to be histologically assessed when multiple polyps are submitted for the Bowel Cancer Screening...

Area of Science:

• Gastroenterology
• Pathology
• Public Health

Background:

• Increasing polyp detection rates in England's Bowel Cancer Screening Programme (BCSP) strains pathology services.
• Pathology workload is rising disproportionately to consultant numbers.
• Optical Diagnosis implementation for BCSP is inconsistent across England.

Purpose of the Study:

• To determine the minimum number of polyps requiring histological assessment for accurate post-polypectomy management in BCSP patients.
• To evaluate if smaller polyps can be discarded after assessing the largest ones.

Main Methods:

• Retrospective analysis of BCSP cases with six or more resected polyps (2016-2024).
• Inclusion criteria: endoscopic report with individual polyp sizes.
• Study cohort comprised 135 cases from a large English teaching hospital.

Main Results:

• Analysis of 135 cases revealed that assessing the seven largest polyps was adequate.
• This assessment correctly guided patient follow-up management according to 2020 British Society of Gastroenterology guidelines.
• 345 out of 8066 BCSP cases met the criteria of having six or more polyps.

Conclusions:

• Histological assessment of the seven largest polyps is sufficient for BCSP patients with multiple polyps.
• Discarding smaller polyps does not impact patient management or BCSP outcomes.
• This strategy can help alleviate cellular pathology workload pressures.